Provider Demographics
NPI:1861421315
Name:WARREN, JOHN HOSKINS (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HOSKINS
Last Name:WARREN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 FAIRVIEW CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3192
Mailing Address - Country:US
Mailing Address - Phone:770-338-8453
Mailing Address - Fax:
Practice Address - Street 1:1708 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2134
Practice Address - Country:US
Practice Address - Phone:770-736-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00968481AMedicaid
GAU73453Medicare UPIN